Wednesday, 29 April 2015

As a dentist, one of the things one has to do,
whether one likes it or not, is interact with the pharmaceutical industry.

I can already see you all wincing when you
read that. Don’t worry, it gets worse.

Now, I assume we’ve all heard bad things
about the pharma industry – for instance, how they would rather “invent a drug
to cure an American of baldness than a million Africans of tuberculosis”, and
so on. Most of these stories are broadly correct, too, but there’s a lot of
other things you find out when you’ve been dealing with them for a while.

For example, you may have had the not
uncommon experience of having been prescribed a medicine, but not being able to
find it in any of the pharmacies you visit – although the same drug, from
another brand, may be available. Or just perhaps five out of six chemists might
not stock it but you’ll find it at the sixth – and only at the sixth.

This is the reason: pharmacies stock
medicines on the basis of the commission offered them by the wholesalers. This commission
can be as little as 5% on the retail price of a medicine, or as high as 50%.
Now, of course, the retailer doesn’t fix the selling price (at least not in
this country) – the manufacturer does. It’s the manufacturer who, therefore,
fixes the margin of profit on the production cost. And the greater the margin
of profit, obviously, the more money is left over for commission payments to
retailers. And also to employ medical representatives to go around plugging
their products to doctors, and to offer said doctors (highly unethical)
freebies to prescribe their products.

You’ll see where this is going. Assuming a
manufacturer has ethics enough not to want to profit mindlessly from the ill
and infirm, he’s going to keep just enough of a profit margin to ensure he can
continue in business. But this will also mean that he can’t afford freebies,
medical reps, sponsored conferences, or, not to miss the point, the all
important commissions which will decide which chemists will stock the drug at
all. Therefore it’s the manufacturer who’s the greediest who wins the largest
share of the market, makes the largest profit – and has enough money left over
to try and ensure the government doesn’t ever impose any kind of price control.

Not that the current run of Indian
governments is interested in imposing price controls on anything anyway.

Then there’s another way of increasing profits
I’ve come across – deliberately squeezing out an effective, but cheaper,
medicine in favour of a more expensive one. One ready example I can give is
combinations of the antibiotic Amoxycillin. Now, a cheap and effective antibiotic
combination is Amoxycillin with Cloxacillin; there’s as yet little bacterial
resistance to this duo, it’s cheap, and has very few side effects as long as
you aren’t allergic to it. But, lately, the combination has virtually vanished
from the market – to be replaced by Amoxycillin with Clavulanic Acid, a
combination whose only virtue is that it costs at least three to five times
more than the combo with Cloxacillin. In my career so far, I have not yet
encountered a single case which was treated with Clavulanic Acid but couldn’t
have been treated as effectively with Cloxacillin. Not a single one.

I know of only one wholesaler in this town which still stocks the Amoxycillin and
Cloxacillin combination – only one. And not coincidentally, the manufacturer
concerned is also one whose products are priced among the lowest, who offers
only a modest commission, and has no medical reps doing the rounds.

I think this manufacturer may be about to
go out of business.

Then there’s something that I’ll speculate
on. You see, no pharmacy waits till the end of its stock of a medicine before
ordering a fresh batch. And since there’s an expiry date on the product, it has
to make sure the drugs are sold before the said expiry date. So what happens if
the pharmacy can’t sell off all of a stock of medicines?

It’s returned to the manufacturer via the
wholesaler for a part refund on the purchase price, that’s what. So just what
do the manufacturers do with the expired medication when it lands up back in their
warehouses?

Destroy it? I...don’t think so.

Maybe I’m unimaginative, or simply
uninformed, but I can imagine them mixing the drug with new material, putting
fresh labels on it, and recycling it back into the market. So maybe fifteen or
twenty percent of your pain medication or asthma spray or whatever is recycled
from expired medicine.

Sunday, 26 April 2015

It has come to my notice that the
earthquake which struck Nepal and India on 25th April was caused by
one of the earth’s tectonic plates pushing against another. Apparently, these
tectonic plates are floating around on top of the earth’s hot inner layers,
just as our ancient Hindu sages had discovered in the past, just as they had
discovered everything else.

Furthermore, I read that our country,
India, that is, Hindustan, is located on top of one of these tectonic plates,
which is called the Indian plate.

I know that a lot of people may find cause
for pride in knowing that this tectonic plate is named for our country, but,
Sir, it is nothing to be proud about. In fact, this tectonic plate is a
traitorous entity and must be fought with all weapons at our command.

I shall explain.

Now, Sir, this Indian plate is actually
moving northwards at the rate of five centimetres per year. Five centimetres
per year may not sound like much, but think of it in the long term. In twenty
years it means the difference of one metre. In a hundred years, it makes a
difference of five metres. And in a thousand years, it means the difference of
fifty metres!

Why is this a matter of concern, Sir? As I
understand it, this Indian tectonic plate is sliding under the edge of the so-called Eurasian tectonic plate as
it advances northwards. Instead of patriotically trampling down the boundaries
of the Eurasian plate, and thus extending our nation’s territories north, it is
treacherously slipping under the edge of the other plate and reducing the size of our nation by five
centimetres per year!

I ask you, Sir, if this is not treachery, what
is? Would we tolerate the activities of anyone determined to steal our land at
the rate of five centimetres per year? I think not.

This Indian Plate must, I feel, be in
league with such enemies of the nation as Maoists, environmentalists,
sickulars, the foreigner Christians and Muslims in our midst, and all the
others who constantly plot against our nation and try to undermine it and give
its territories to Pakistan and China. We must, therefore, immediately tackle
it on a war footing.

First of all, we can no longer tolerate it
being called the Indian plate. As a
traitor, it has lost the right to call itself Indian. Since it is an enemy, we
should call it by the name of an enemy, and thus refer to it from this moment
on as the Pakistani plate.

But just changing its name will achieve
nothing, because the continued northwards movement of this Pakistani plate will
mean that our country will keep getting smaller and so the enemy will win.
Therefore, we must immediately take all measures to punish it and force it to
stop its northward movement.

How should we do this? Our ancient Hindu
sages, as with all other things, knew the answer. Sir, we must at once drill
deep shafts all along the boundaries of this Pakistani plate, and explode
nuclear bombs inside them. This will force the plate to stop its northward movement, and to understand the consequences of stealing sacred Hindu land. And it will also
find a use for the nuclear bombs e have and provide a reason to manufacture more bombs.

We can carry out the project as in this diagram, only much deeper.

You will have noted that part of the boundaries of the Pakistani plate are on the territory of other nations, such as the so-called country of Pakistan. These inferior countries will, of course, refuse to let us drill shafts inside their territories. But that is something that must not be allowed to stop us, for this is a fight for our national existence. Sir, we must immediately send our glorious Indian Army and conquer these countries, which in any case were all sacred Hindu land in the past and must be made so again.

And once the territory is under our control and the required number of nuclear bombs are ready, we might as well round up all the
Maoists, environmentalists, sickulars, Christians, Muslims, and other enemies
of the nation and force them to dig these shafts. After all, what else are these
vermin good for?

I realise that your political opponents
will make noises about this, but, Sir, all that means is that they, too, are in
league with these enemies and you should get rid of them as well. Set them to
digging shafts, it will teach them a lesson and also give you a free hand
politically to advance your policies free from interference.

It is also true that these nuclear explosions may cause some more earthquakes, and kill some millions in the process. But blood sacrifices are necessary to achieve goals, and are in the tradition of our glorious Hindu civilisation, as you know. And, once the task is over, all Hindu women can be ordered to produce at least ten children to restore the population.

I would suggest that you consider giving the project an appropriate name, like Operation Save Hindustan.

With humble sincerity, and urging you to
take quick steps in this matter,

Jai Bajrang Bharat
SuperHindustani.

P.S. There is no time to lose! Every year we waste means a loss of five more centimetres of sacred Hindu soil. Never forget that.

This is for those of you who know of my geographical
location and the earthquake that struck Nepal and Northern India yesterday:
yes, I’m all right. And, yes, I did feel it.

I was at that time talking to a specimen, whose
teeth I’d just done checking. All of a sudden I started feeling queasy, as
though I were seasick. This was very strange since it started with no warning,
and I didn’t know the reason. I was sitting down, so it wasn’t as though this
was the result of postural hypotension – the phenomenon when you get dizzy when
you get up suddenly because the blood flow to your brain is temporarily
reduced. I continued speaking to the specimen as this nausea continued, for the
better part of a minute. And then, all of a sudden, I realised that it was an
earthquake – only not one like I’d ever felt before.

Hereabouts, earthquakes are extremely
common events, since it’s one of the world’s most seismically active zones,
what with the Indian tectonic plate ramming itself under the edge of the Asian
tectonic plate, thus pushing up the Himalayas. We’re all very used to quakes –
once when I was a teenager we had four earthquakes in the course of one
evening, with a power cut on top of it. However, those quakes are totally different, generally a fast approaching
rumbling noise followed by a few seconds of hard shakes. This is the first time
I’ve ever felt an earthquake which made the entire multi-storey building where
I have my clinic rock from side to side on its foundations like a ship on the
sea. And it was all in complete silence, which for some reason made it even
more unnerving.

What did I do when I realised that it was
an earthquake? Nothing. There was nothing to do. By that time the shaking was
already slowing down, but even if it hadn’t, there was nothing I could have
done. If the building was going to come down, five upper floors would have
crashed on my head long before I could have made the open. And it was raining
hard anyway.

What did the specimen do, you ask? Nothing.
She was one of those spaced out types, and I don’t know if she even noticed the
quake.

It was only afterwards that I heard about
the huge quake in Nepal. Obviously, we felt the margins of that tremor, which
seems to have set the crust of the northern Indian subcontinent to quivering
like a jelly. If the epicentre of the quake had been closer, they’d have had to
scrape me off the broken masonry with a spoon. Just under my clinic’s floor is
the basement parking lot, supported by pillars which would snap like twigs.

And this is a major problem. Earlier,
construction in this seismic zone took into consideration the phenomenon of
earthquakes – one of which destroyed this town in 1897. Houses were built of
light materials, mostly wood, wattles and corrugated tin roofing. They’d ride
the waves of the quake rather than resist and be smashed. Even if they did
fall, they were so light most people had an excellent chance of emerging from
the debris largely unscathed. But that kind of house is almost extinct now.
Everyone’s building concrete monstrosities with all the chances of a castle of
cards if a hard quake comes along.

What is the government doing about it?
Nothing – unless you count taking bribes to look the other way when over-rich
fatcats ignore building regulations and build anything they want, any way they
want.

Here are some pictures of the aftermath of
the quake, from Nepal:

I am, incidentally, somewhat surprised that
this news has made the major international media. After all, this didn’t happen
in Warshington Dee Cee.

Incidentally, owing to things happening in my personal life, I've not had the time or inclination for writing or drawing these last few days. I hope and expect those things will be cleared up in the next few days. Until then, keep living.